Effects of physical activity and air pollution on blood pressure
Introduction
In 2016, high systolic blood pressure was classified as the third leading risk factor for global burden of disease, causing 10.4 million deaths and 212.1 million disability-adjusted life years (DALYs) (GBD 2016 Risk Factors Collaborators, 2017). High blood pressure has been defined as the strongest modifiable risk factor for cardiovascular disease and related disability worldwide (Olsen et al., 2016). An increase of blood pressure levels can be due to several factors.
An important determinant of blood pressure levels is physical activity. Physical activity is known to reduce the risk of many adverse health outcomes, partly because of its beneficial influence on systemic inflammation (Zhang et al., 2017). Regular physical activity reduces risk of cardiovascular events, and it has also been suggested that physical activity attenuates the air pollution-related increases in blood pressure (Kubesch et al., 2015). Having low physical activity accounted for 1.4 million deaths and 24.3 million DALYs in 2016, and was classified as the 14th risk factor in terms of global DALYs (GBD 2016 Risk Factors Collaborators, 2017). Also, sedentary behaviours have been increasingly associated with health conditions such as obesity, diabetes, metabolic syndrome, cardiovascular disease, and death (Same et al., 2016).
In addition, long-term and short-term exposure to air pollution has been suggested as an important environmental risk factor associated with an increase in blood pressure levels (Louwies et al., 2015; Magalhaes et al., 2018; Yang et al., 2018), and also with other cardiovascular outcomes such as hypertension, heart failure hospitalisation and mortality, decreases in heart-rate variability, and progression in coronary calcification (Chen et al., 2015; Fuks et al., 2016, 2014; Kaufman et al., 2016; Requia et al., 2017; Shah et al., 2013; Weichenthal et al., 2014a; Zhao et al., 2014). In 2016, air pollution was classified as the fifth leading risk factor for global burden of disease, with ambient particulate matter pollution as the most important cause of disease among environmental risk factors, leading 4.0 million deaths and 105.7 million DALYs (GBD 2016 Risk Factors Collaborators, 2017).
Most evidence supports a positive association between air pollution and blood pressure (Magalhaes et al., 2018; Yang et al., 2018). But some studies of specific traffic-related pollutants such as black carbon show no association (Chung et al., 2015; Weichenthal et al., 2014b; Williams et al., 2012) or even inverse associations (Mirowsky et al., 2015). The majority of these studies used measures from fixed monitoring stations, possibly leading to exposure measurement error, and hence null effects. The literature on physical activity and benefits in blood pressure level is mostly consistent (Cornelissen et al., 2011). But we found only one study assessing the effects of traffic-related air pollution and physical activity and their interaction effects with blood pressure (Kubesch et al., 2015). The study found independent opposite effects of traffic-related air pollutants and physical activity on blood pressure, and only evidence for an interaction between physical activity and PM10 and PMcoarse leading to increased systolic blood pressure.
There is a need to better understand the association between air pollution, including black carbon and blood pressure levels, using other, and probably better air pollution measurement methods such as personal monitoring. Moreover, there is a need to better understand the interaction between black carbon and physical activity and its effects on blood pressure using varying urban environments and well-designed observational studies, as the study found with similar design had a very small sample size (28 healthy adults), and it was done in one city.
The main aim of this study was to assess the main and interaction effects of black carbon and physical activity on systolic and diastolic blood pressure, in a healthy adult population from three European cities using objective personal measurements over short-term (hours and days) and long-term exposure.
Section snippets
Study design and population
A panel study was performed in three European cities (Antwerp, Barcelona, and London) as part of the PASTA (Physical Activity through Sustainable Transport Approaches) project (Gerike et al., 2016). Participants were recruited from the PASTA longitudinal study (Dons et al., 2015), in which they answered an online survey on transport, physical activity, and health, and expressed their willingness to participate in a sub-study using sensors. Participants had to fulfil the following inclusion
Results
From the total of 122 healthy adults who participated in the study, 119 completed all three measurement weeks; one participant completed two measurement weeks, and two participants completed one week of measurement. Sociodemographic characteristics, exposure and outcome measures are presented in Table 2.
Fig. 1, Fig. 2, Fig. 3 show the results of single and multiple exposure models evaluating associations between black carbon and physical activity measures with systolic and diastolic blood
Summary of results
In this fairly large study with objective short-term (hours and days) and long-term personal measurements in a healthy adult population, we found that in single exposure models, black carbon was associated with lower levels of systolic blood pressure after 1–4 h of exposure. Moderate-to-vigorous physical activity was associated with lower levels of systolic blood pressure after 1 h to 8 h of exposure, after 12 h of exposure, after 4 days of exposure, and after long-term exposure. In multiple
Conclusions
The results from this study provided evidence that short-term and long-term exposure to moderate-to-vigorous physical activity is associated with a decrease in systolic blood pressure levels. We did not find evidence for a consistent main effect of black carbon on blood pressure, nor for interaction effects between black carbon and physical activity levels.
Funding
This work was supported by the European project PASTA, which had partners in London, Rome, Antwerp, Örebro, Vienna, Zurich, and Barcelona. PASTA (http://www.pastaproject.eu/) was a 4-year project funded by the European Union’s Seventh Framework Program under EC-GA No. 602624-2 (FP7-HEALTH-2013-INNOVATION-1). ML was supported by a VITO PhD scholarship (project number 1410533; www.vito.be). ED was supported by a postdoctoral scholarship from FWO Research Foundation Flanders (grant number: 12L8815N
Declarations of interest
None.
Acknowledgements
ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya. The authors are grateful to the participants of the Physical Activity through Sustainable Transportation Approaches (PASTA) Health add-on study. We would like to acknowledge David Martínez, Esther Gracia, and Sandra Márquez for their help with the statistical analyses; and Elisa Pasqual for her help in the better understanding of the biological mechanisms, by which air pollutants cause cardiovascular effects.
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